I recently had an appointment with my doctor that started off with him telling me, ominously, that there would "be some changes in [his] practice." He assured me that they were changes that would improved the level of attention I received, and that there would be someone in to tell me about it later.
Sure enough, when the appointment was ending, he returned to the examining room with a woman in tow. Carrying pamphlets. She informed me that my doctor's practice was going to become a "concierge" practice. Actually, I'm not quite sure if the marketing spiel she gave used the word "concierge", but after I looked up her company's website and searched some more that seemed to be the common label affixed to it.
If you're in the dark, as I was, a concierge practice amounts to you, the patient, paying a fee to use this particular doctor. The fee ranges in price, with the average I've seen quoted on the web as $1500 a year. My doctor wants $1800 a year. Keep in mind, this is a fee that isn't covered by insurance although it may qualify for a "flex" account you belong to. Paying the fee doesn't change anything about your medical expenses as they have been in the past with regards to insurance coverage. You still have to pay your deductibles.
Of course, there are some benefits that are touted in the marketing for the "product". The main ones that I remember are; a comprehensive physical ("This level of physical alone would cost you $4000!"), computerized medical records ("We even give you a CD you can keep!"), and 24/7 access to your doctor ("On his personal cell phone!"). During this whole encounter, it felt a lot like a meeting you might go to after there have been layoffs at your company. The one where they talk convincingly about how it's a "Good Thing!".
On the doctor's side, he promises to keep his practice to under a certain number of patients. I think the number I heard was 600. So, 600 patients paying $1800 a year each comes out to $1,080,000 a year. From what I've seen, the management company takes a one third cut, leaving the doctor with about $720,000 a year from the "subscription fee" alone. The economics of a medical office are pretty complex, so after paying his staff, malpractice insurance, and other costs associated with his business, the doctor ends up with nowhere near this amount in the end. It's also unfair to say this amount is over an above the income he was already making, because the number of patients has been cut to probably one third of his pre-concierge practice.
So, for $1800 a person -- did I mention that each person in the family pays this fee? -- you get a physical and more access to your doctor. So a family of four would pay $7200 a year. The only demographic I can imagine this being attractive to are high income older folks. They can afford the high fees, and they typically have a greater need for high doctor availability.
Is there something I'm missing beyond the marketing hit list?
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Posted by Rob at April 9, 2007 06:33 PMActually it doesn't sound that bad to me, but then maybe I fall into the demographic you mention.
Just last week I had my first routine physical since... well ever, actually. I did this because I feel I'm getting to an age where I want to have a history with a physician, someone who is going to treat me as something other than 5 minutes and a billing code.
600 patients. 40 working weeks a year (assuming they are generous with their vacations) works out to 3 patients a day if each patient comes once per year. I would hope to get a higher level of service in this sort of scheme...
But again, I can see where this would vary by person. I really like having long term relationships with service providers.
I've been seeing the same dentist for something like 12 years.
I've been having my haircut by the same person for 19 years.
I've been seeing the same optometrist for about 25 years.
When it comes time to really needing medical advice I'd like to have a similar history with a doctor, even if it means paying for it.
Our alternate doctor at the office of our doctor went concierge last year, but also off the insurance plan. She said that it was geared towards people with higher medical needs, complicated conditions like say advanced diabetes, or something of that sort. So, perhaps if someone finds themselves at the doctor all the time, it works out better. It freaked me out when she explained it though since I had never heard of it either. Apparently, it has been gaining popularity over the last few years.
Posted by: Bob Evans at April 9, 2007 10:55 AMJeff - I agree, having a long term relationship with a doctor is my preference, too. That's why I opt for PPO coverage. I've had this doctor for over ten years, which makes the decision of whether or not to pay the membership fee a tough one. In fact, it's the only reason I haven't declined yet. The "better level of service" advantage is mentioned during the sales pitch, but I've been happy with my level of service. My tune would change if I were diagnosed with something chronic that had the potential of becoming life threatening quickly.
Posted by: Rob at April 9, 2007 12:06 PMBob -- I was surprised at how long the concept has been around when I started doing some research. It isn't without its share of controversy, either. This trend at the "high end" of medical service, combined with a decrease in the number of young doctors starting general practices is more than a little disconcerting.
Posted by: Rob at April 9, 2007 12:11 PMSo, I agree that this is not new...it is, however, increasing in popularity in areas of the country that are seeing a rapid influx of people and money (and/or people with money). Affluent families will pay for something unattainable by most. Families in "Podunk, OH" may not have the means to pay for this coverage...nor the need. They have had a single family physician for many years. They receive the personal attention many of us hope to attain. Many concierge services even offer "house calls" that these families receive for free.
Concierge service is meant to give you a more personal service. A service similar to what we all used to have. Physicians, now, see more patients per day because the insurance companies take such a large cut and because malpractice insurance is so high due to our litigious society. They need to squeeze in more to make the same amount of money! Believe me…doctors DO NOT make what they used to. The same is true with hospitals. I’d be more concerned with concierge service at my hospital of choice…that is where I want the speediest most thorough service.
Convenience has a price...but, I would not compare or contrast Concierge Medicine to HMO's or PPO's. For the same reason Rob has joined a PPO (to see the same physician every time), I have joined an HMO. That and the fact that I have a fairly fixed annual medical expenditure...no large unexpected Out-of pocket expenses. Okay…back to the HMO. Yes, I am limited to who I see...but, isn’t that what we are looking for. I was selective and did my research…it cost time. It did not cost $$$. I interviewed physicians and asked for personal referrals. I was selective in choosing a physician with only one other physician in her practice. I was selective in choosing a physician with a fairly small patient pool. I was selective in choosing a physician with a specialty in an area which I need. I was selective in choosing a physician who has been able to see me within a day of every requested appointment, I was selective in choosing a physician who had privileges at the two hospitals which were most important to me. I was selective enough to do this without shelling out another $2000/year. The same research that is done before buying a car, choosing a TV or purchasing a home…was done before I chose my doctor. Of course, I could also pay someone to tell me which Car to buy, make an appointment with a sales person and hold my hand while signing on the dotted line. I’m sure someone out there offers that service. But, I’m much too frugal. I’ll do my research the old fashion way and use that $2000 to buy a TV
Does anyone know if the concierge fee would be deuctible as a medical expense on one's income tax return? I suspect not, as it generally covers enhanced services that are not directly medical related.
Posted by: herman minkowski at April 20, 2007 08:14 AMI don't think so, Herman, although I would check with a tax professional. Your best bet, if you're in the U.S., is if your company has a medical "Flex" account. In that case, you can usually charge the fee against that pre-tax account. For me, the unfortunate timing of my doctor's announcement was another strike against it. I had already submitted the forms for my deductions, so couldn't make up for the added expense in my Flex account.
Posted by: Rob at April 20, 2007 08:35 AM